What is Alopecia? Alopecia is a collective medical term used to describe conditions characterized by unusual hair loss. Alopecia is not a contagious disease. Specialists have linked several types of Alopecia to lifestyle, genetics, environmental factors, and, in some cases, psychological factors that result in hair pulling.
There are two classifications: non-scarring and scarring forms of Alopecia. Hair loss affects people of all ages, genders, and ethnicities.
Types of Alopecia
Non-Scarring Alopecia
Non-scarring Alopecia is hair loss that does not destroy the hair follicles, leaving a possibility of hair regrowth. It includes alopecia areata (AA), Alopecia androgenetic (AGA), Traction Alopecia, and Trichotillomania.
- Alopecia Areata (AA)
Alopecia Areata, an autoimmune disorder, is one of the most common types of Alopecia, whereby the immune system attacks healthy hair follicles, leading to hair loss.
Some characteristics of AA include patchy hair fall, which can also affect eyelashes, eyebrows, and any other hairy body part.
Researchers are still trying to establish the leading cause of Androgenetic Alopecia. At least 20% of people with AA have a close relative suffering from the condition. Thus, specialists have linked AA to genetics.
- Androgenetic Alopecia (AGA)
Androgenetic Alopecia, also known as female-pattern hair loss or male-pattern baldness, is a form of Alopecia common in both genders. Specialists attribute the patterned baldness to genetics and environmental factors.
- Male pattern: Hair loss starts on the crown with a receding hairline but rarely affects the sides and back of the head. It affects over 50% of males over the age of 50.
- Female pattern: Most common in older women, affecting about 50% of females above 65. Women rarely experience a receding hairline. Instead, tufts of hair go missing over the entire scalp, leading to general thinning.
- Traction Alopecia (TA)
Unlike other hair loss disorders, physical strain on hair follicles is the leading cause of Traction Alopecia (TA). TA occurs on any area of the scalp that is under strain.
These include:
- Wearing the hair tightly in dreadlocks, braids, or a ponytail
- Tight headgear
- Harmful chemical relaxers
- Heavy hair extensions
Long-term strain on follicles results in frequent loss of strands of hair and might result in permanent damage to the hair follicles.
- Trichotillomania (Hair Pulling)
Also classified as an Obsessive-Compulsive Disorder (OCD) disorder, Trichotillomania is the overwhelming urge to pull out your hair. People diagnosed with the disorder often experience anxiety or tension, which they relieve by pulling out hair from different parts of the body, such as the head, pubic, or even the face, followed by a sense of gratification afterward.
Hair pulling is more common in females than males and is prevalent among teenagers and young adults.
Forms of Trichotillomania are:
- Focused hair-pulling (intentional)
- Automatic hair-pulling (subconscious)
- Mixture of both focused and automatic hair-pulling
Both genetics and environmental factors can cause Trichotillomania.
Scarring Alopecia
Scarring Alopecia includes forms that destroy hair follicles, leaving scars on the scalp skin, which can prevent hair regrowth. Forms are Central Centrifugal Cicatricial Alopecia (CCCA), Frontal Fibrosing Alopecia (FFA), Lichen Planopilaris (LPP) and Folliculitis Decalvans (FD).
- Central Centrifugal Cicatricial Alopecia (CCCA)
Central Centrifugal Cicatricial Alopecia (CCCA), as the name suggests, is a scarring Alopecia that starts at the scalp’s center, gradually thinning the hair to leave scar tissue. Bad hair-grooming habits, with low chances of genetic interference, can trigger the disorder.
CCCA is very common among middle-aged women of African ancestry, but in rare cases, it affects both men and women of all ethnicities. Hair loss is permanent but can be managed by slowing or stopping it altogether.
- Frontal Fibrosing Alopecia (FFA)
This form of scarring Alopecia affecting the front part of the scalp is a form of localized inflammatory Condition-Lichen Planopilaris.
FFA causes slow but progressive hair loss, especially in postmenopausal women. Although linked mainly to hormonal changes, FFA may affect younger men and women, not only on the forehead but also on the eyes and other hairy body parts. In severe cases, FFA attacks the fine hairs on the face and hands, causing skin-colored bumps known as papules.
- Lichen Planopilaris (LPP)
Lichen Planopilaris, or LPP, is another form of scarring hair loss that affects the mucous membrane and scalp skin. Common in women, some characteristics of LPP include scaly skin, bald patches, a red scalp, itching, and a painful burning sensation. Anyone can be affected by the disease; however, it is very prevalent in women between the ages of 30 and 60.
Specialists have yet to establish the cause of LPP, but it is termed a hair follicle autoimmune disorder.
- Folliculitis Decalvans
Folliculitis Decalvans (FD) is a long-term (chronic) rare scarring alopecia that causes inflammation of the hair follicles.
FD is standard in middle-aged adults and can lead to permanent hair loss caused by permanent scarring on the affected areas.
It is one of the most persistent forms of hair loss attributed to its prolonged autoimmune nature.
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References
Bittencourt, C., Ferraro, D. A., Soares, T. C. B., Moraes, A. M., & Cintra, M. L. (2014). Chronic telogen effluvium and female pattern hair loss are separate and distinct forms of alopecia: a histomorphometric and immunohistochemical analysis. Clinical and Experimental Dermatology, 39(8), 868–873. https://doi.org/10.1111/ced.12406
Moseley, I., George, E. A., Tran, M., Lee, H., Qureshi, A. A., & Cho, E. (2023). Alopecia areata in underrepresented groups: preliminary analysis of the all of us research program. Archives of Dermatological Research, 315(6), 1631–1637. https://doi.org/10.1007/s00403-023-02548-y
Ogechi Ezemma, Shivali Devjani, Balaji Jothishankar, Kelley, K. J., & Senna, M. (2023). Racial and Ethnic Diversity in Janus Kinase Inhibitor Alopecia Areata Clinical Trials: A Systematic Review. Skin Appendage Disorders, 9(5), 351–354. https://doi.org/10.1159/000531219
Sperling, L. C., & Cowper, S. E. (2006). The Histopathology of Primary Cicatricial Alopecia. Seminars in Cutaneous Medicine and Surgery, 25(1), 41–50. https://doi.org/10.1016/j.sder.2006.01.006
